Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications

Title order Author order Journal order Date order
Category: Exercise

Title: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae
Author: Jones DR, Speier J, Canine K, Owen R, Stull GA
Affiliation: Sister Kenny Institute, Minneapolis, Minn (Mr Jones and Drs Speier, Canine, and Owen)
School of Health Related Professions, State University of New York at Buffalo (Dr Stull)
Journal: The Journal of the American Medical Association
Citation: JAMA. 1989 Jun 9;261(22):3255-58
Publication Year and Month: 1989 06

Abstract: We examined the cardiorespiratory responses of 16 patients with postpoliomyelitis sequelae to a 16-week aerobic exercise program. The patients exercised at 70% of maximal heart rate. Dependent variables were resting and maximal heart rates, systolic and diastolic blood pressures, maximum oxygen consumption, maximum carbon dioxide consumption, respiratory quotient, and maximum expired volume per unit time. The exercise group was superior to the control group in watts, exercise time, maximum expired volume per unit time, and maximum oxygen consumption. No untoward events or loss of leg strength occurred as a result of the exercise regimen. We conclude that the aerobic training program employed in this study is a safe, short-term procedure and that patients with postpolio sequelae respond to training in a manner similar to healthy adults.

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Category: Exercise

Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09

Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.

Design: Observational study.

Participants: Thirty-three polio survivors, able to walk ≥ 150 m.

Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.

Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.

Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.

Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.

Outcome of Research: Effective

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Category: Exercise

Title: Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription
Author: Voorn EL (1), Gerrits KH (2), Koopman FS (3), Nollet F (3), Beelen A (3)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected]; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2014 May;95(5):935-40. doi: 10.1016/j.apmr.2014.01.015
Publication Year and Month: 2014 05

Abstract: OBJECTIVES: To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT.

DESIGN: Cohort study.

SETTING: Research laboratory.

PARTICIPANTS: Individuals with PPS (N=82).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, gas exchange variables, heart rate, and rating of perceived exertion (RPE) were measured in an incremental submaximal cycle ergometry test. Two independent observers identified the AT. Comparison of current guidelines for training intensity prescription in PPS (40%-60% heart rate reserve [HRR] or RPE of 12) with the AT was based on correlations between recommended heart rate and the heart rate at the AT. In addition, we determined the proportion of individuals that would have been recommended to train at an intensity corresponding to their AT.

RESULTS: The AT was identified in 63 (77%) of the participants. Pearson correlation coefficients between the recommended heart rate and the heart rate at the AT were lower in cases of 40% HRR (r=.56) and 60% HRR (r=.50) than in cases of prescription based on the RPE (r=.86). Based on the RPE, 55% of the individuals would have been recommended to train at an intensity corresponding to their AT. This proportion was higher compared with 40% HRR (41%) or 60% HRR (18%) as criterion.

Conclusions: The AT can be identified in most individuals with PPS offering an individualized target for aerobic training. If the AT cannot be identified (eg, because gas analysis equipment is not available), intensity prescription can best be based on the RPE.

Outcome of Research: Not applicable

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Category: Exercise

Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01

Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.

Outcome of Research: Effective.

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Category: Exercise

Title: Effect of modified aerobic training on movement energetics in polio survivors
Author: Dean E, Ross J
Affiliation: School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1243-6
Publication Year and Month: 1991 11

Abstract: Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.

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Category: Exercise

Title: Endurance Training Effect on Individuals With Postpoliomyelitis
Author: Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar Grimby, MD, PhD
Affiliation:
Journal:
Citation: Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996;77:843-8.
Publication Year and Month: 1996

Abstract: Objective: To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.

Design: Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.

Setting: A university.

Subjects: Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.

Intervention: Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.

Main Outcome Measures: Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.

Conclusions: Results: Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.

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Category: Exercise

Title: Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome
Author: Vreede KS, Henriksson J, Borg K, Henriksson M
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013 Sep;45(9):924-8. doi: 10.2340/16501977-1209.
Publication Year and Month: 2013 09

Abstract: OBJECTIVE: To evaluate gait in patients with post-polio syndrome, using the 6-minute walk test (6MWT) combined with three-dimensional kinematic analysis.

DESIGN: Descriptive study.

SUBJECTS: Eighteen patients and 11 healthy controls.

METHODS: Kinematic data were obtained during a 6MWT by a Vicon motion capture system. Distance, heart rate, leg tiredness, dyspnoea and exertion were also recorded.

RESULTS: Patients with post-polio syndrome showed larger increases in leg tiredness (p < 0.001) and dyspnoea (p < 0.05) as a result of the 6MWT than did controls. Walking speed decreased by 14.1% in patients vs 4.7% in controls (p < 0.05). Fourteen out of 18 patients displayed plantar-flexed ankle at initial contact (1/11 controls). At foot-off, the patients had a flexed hip (extended in controls) and a more flexed knee. Walking speed in patients correlated with hip angle at footoff, at the start (r = –0.60, p < 0.001) and the end of the 6MWT (r = –0.74, p < 0.001), being higher the more the hip was extended.

CONCLUSION: The 6MWT is fatiguing for patients with post polio syndrome, and this was reflected in the kinematic data. Walking speed was negatively correlated with the increased hip flexion, but not with the ankle plantar-flexion at foot-off in the patients with post-polio syndrome. The three-dimensional results underscore the importance of hip function in this patient group.

Conclusions:

Outcome of Research: Not applicable.

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Category: Exercise

Title: Polio residuals clinic: conditioning exercise program
Author: Owen RR, Jones D
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):882-3
Publication Year and Month: 1985 07

Abstract: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.

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Category: Exercise

Title: Post-polio fatigue: a 31P magnetic resonance spectroscopy investigation
Author: Thompson RT, Barton PM, Marsh GD, Cameron MG, Gravelle DG, Hsieh JT, Hayes KC, Driedger AA
Affiliation: Department of Nuclear Medicine, St. Joseph's Health Center, London, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1263-7
Publication Year and Month: 1991 11

Abstract: Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls using 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.

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Category: Exercise

Title: Postpolio syndrome and cardiopulmonary conditioning
Author: Owen RR
Affiliation: Sister Kenny Institute, Minneapolis, Minnesota 55407
Journal: The Western Journal of Medicine
Citation: West J Med. 1991 May;154(5):557-8 (Rehabilitation Medicine - Adding Life to Years [Special Issue])
Publication Year and Month: 1991 05

Abstract: Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.

Conclusions: Stretching and flexibility exercises are critical physical hygiene measures for the management of pain, instability, and deformity. These exercises should also precede cardiopulmonary conditioning and other vigorous physical pursuits. Muscle training and strengthening when carefully defined and judiciously implemented can safely build force and power. Resistive exercises should be prescribed for specific goals rather than for purposes of general muscle training. An adapted cardiopulmonary conditioning program has been created to provide improved cardiac status without the risk of overuse damage to nerve and muscle.

The management of postpolio syndrome requires applying traditional physical treatment principles with specific attention to the factors of the vulnerability of compensatory mechanisms to injury by overuse, underuse, underoxygenation, and an inefficient use of weakened musculature. Clinicians must provide information and a balanced prescription of exercise, rest, activity, support, and intelligent accommodation to additional disability.

Outcome of Research: Not applicable.

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Category: Exercise

Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03

Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.

The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.

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Outcome of Research: Not applicable

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Category: Exercise

Title: Submaximal exercise capacity and maximal power output in polio subjects
Author: Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Dec;82(12):1678-85
Publication Year and Month: 2001 12

Abstract: OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.

DESIGN: Cross-sectional survey.

SETTING: University hospital.

PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.

RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.

Conclusions: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.

Outcome of Research: Not applicable

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Category: Exercise

Title: The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome
Author: Fillyaw MJ, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A
Affiliation: Department of Physical Therapy, University of Vermont, Burlington
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1253-6
Publication Year and Month: 1991 11

Abstract: Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.

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Category: Exercise

Title: The Postpolio Syndrome: An Overuse Phenomenon


Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

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Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Category: Exercise

Title: The use of strengthening exercises in post-polio sequelae - methods and results
Author: Feldman RM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):889-90
Publication Year and Month: 1985 07

Abstract: Some individuals who had poliomyelitis 20 to 30 years ago are now reporting a recurrence of symptoms of weakness in the same muscle groups that were weakened during the initial onset of the disease. Electrophysiological findings on EMG and repetitive stimulation studies identify changes peculiar to this disease. Non-fatiguing progressive resistive exercises have been used to strengthen muscle groups demonstrating this secondary weakness after the muscles have been identified by electrophysiological studies. Favorable results are reported after non-fatiguing exercises which, combined with Occupational Therapy and appropriate orthotic management, have resulted in improvement in function of ambulation and activities of daily living. The causes of muscle atrophy and pain seen in these individuals are also discussed.

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Category: Exercise

Title: Endurance Training Effect on Individuals With Postpoliomyelitis
Author: Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar Grimby, MD, PhD
Affiliation:
Journal:
Citation: Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996;77:843-8.
Publication Year and Month: 1996

Abstract: Objective: To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.

Design: Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.

Setting: A university.

Subjects: Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.

Intervention: Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.

Main Outcome Measures: Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.

Conclusions: Results: Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.

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Category: Exercise

Title: Effect of modified aerobic training on movement energetics in polio survivors
Author: Dean E, Ross J
Affiliation: School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1243-6
Publication Year and Month: 1991 11

Abstract: Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.

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Category: Exercise

Title: The use of strengthening exercises in post-polio sequelae - methods and results
Author: Feldman RM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):889-90
Publication Year and Month: 1985 07

Abstract: Some individuals who had poliomyelitis 20 to 30 years ago are now reporting a recurrence of symptoms of weakness in the same muscle groups that were weakened during the initial onset of the disease. Electrophysiological findings on EMG and repetitive stimulation studies identify changes peculiar to this disease. Non-fatiguing progressive resistive exercises have been used to strengthen muscle groups demonstrating this secondary weakness after the muscles have been identified by electrophysiological studies. Favorable results are reported after non-fatiguing exercises which, combined with Occupational Therapy and appropriate orthotic management, have resulted in improvement in function of ambulation and activities of daily living. The causes of muscle atrophy and pain seen in these individuals are also discussed.

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Category: Exercise

Title: The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome
Author: Fillyaw MJ, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A
Affiliation: Department of Physical Therapy, University of Vermont, Burlington
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1253-6
Publication Year and Month: 1991 11

Abstract: Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.

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Category: Exercise

Title: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae
Author: Jones DR, Speier J, Canine K, Owen R, Stull GA
Affiliation: Sister Kenny Institute, Minneapolis, Minn (Mr Jones and Drs Speier, Canine, and Owen)
School of Health Related Professions, State University of New York at Buffalo (Dr Stull)
Journal: The Journal of the American Medical Association
Citation: JAMA. 1989 Jun 9;261(22):3255-58
Publication Year and Month: 1989 06

Abstract: We examined the cardiorespiratory responses of 16 patients with postpoliomyelitis sequelae to a 16-week aerobic exercise program. The patients exercised at 70% of maximal heart rate. Dependent variables were resting and maximal heart rates, systolic and diastolic blood pressures, maximum oxygen consumption, maximum carbon dioxide consumption, respiratory quotient, and maximum expired volume per unit time. The exercise group was superior to the control group in watts, exercise time, maximum expired volume per unit time, and maximum oxygen consumption. No untoward events or loss of leg strength occurred as a result of the exercise regimen. We conclude that the aerobic training program employed in this study is a safe, short-term procedure and that patients with postpolio sequelae respond to training in a manner similar to healthy adults.

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Category: Exercise

Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09

Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.

Design: Observational study.

Participants: Thirty-three polio survivors, able to walk ≥ 150 m.

Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.

Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.

Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.

Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.

Outcome of Research: Effective

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Category: Exercise

Title: Submaximal exercise capacity and maximal power output in polio subjects
Author: Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Dec;82(12):1678-85
Publication Year and Month: 2001 12

Abstract: OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.

DESIGN: Cross-sectional survey.

SETTING: University hospital.

PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.

RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.

Conclusions: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.

Outcome of Research: Not applicable

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Category: Exercise

Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03

Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.

The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.

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Category: Exercise

Title: Postpolio syndrome and cardiopulmonary conditioning
Author: Owen RR
Affiliation: Sister Kenny Institute, Minneapolis, Minnesota 55407
Journal: The Western Journal of Medicine
Citation: West J Med. 1991 May;154(5):557-8 (Rehabilitation Medicine - Adding Life to Years [Special Issue])
Publication Year and Month: 1991 05

Abstract: Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.

Conclusions: Stretching and flexibility exercises are critical physical hygiene measures for the management of pain, instability, and deformity. These exercises should also precede cardiopulmonary conditioning and other vigorous physical pursuits. Muscle training and strengthening when carefully defined and judiciously implemented can safely build force and power. Resistive exercises should be prescribed for specific goals rather than for purposes of general muscle training. An adapted cardiopulmonary conditioning program has been created to provide improved cardiac status without the risk of overuse damage to nerve and muscle.

The management of postpolio syndrome requires applying traditional physical treatment principles with specific attention to the factors of the vulnerability of compensatory mechanisms to injury by overuse, underuse, underoxygenation, and an inefficient use of weakened musculature. Clinicians must provide information and a balanced prescription of exercise, rest, activity, support, and intelligent accommodation to additional disability.

Outcome of Research: Not applicable.

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Category: Exercise

Title: Polio residuals clinic: conditioning exercise program
Author: Owen RR, Jones D
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):882-3
Publication Year and Month: 1985 07

Abstract: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.

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Category: Exercise

Title: The Postpolio Syndrome: An Overuse Phenomenon


Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

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Outcome of Research: Not applicable

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(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Category: Exercise

Title: Post-polio fatigue: a 31P magnetic resonance spectroscopy investigation
Author: Thompson RT, Barton PM, Marsh GD, Cameron MG, Gravelle DG, Hsieh JT, Hayes KC, Driedger AA
Affiliation: Department of Nuclear Medicine, St. Joseph's Health Center, London, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1263-7
Publication Year and Month: 1991 11

Abstract: Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls using 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.

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Category: Exercise

Title: Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription
Author: Voorn EL (1), Gerrits KH (2), Koopman FS (3), Nollet F (3), Beelen A (3)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected]; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2014 May;95(5):935-40. doi: 10.1016/j.apmr.2014.01.015
Publication Year and Month: 2014 05

Abstract: OBJECTIVES: To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT.

DESIGN: Cohort study.

SETTING: Research laboratory.

PARTICIPANTS: Individuals with PPS (N=82).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, gas exchange variables, heart rate, and rating of perceived exertion (RPE) were measured in an incremental submaximal cycle ergometry test. Two independent observers identified the AT. Comparison of current guidelines for training intensity prescription in PPS (40%-60% heart rate reserve [HRR] or RPE of 12) with the AT was based on correlations between recommended heart rate and the heart rate at the AT. In addition, we determined the proportion of individuals that would have been recommended to train at an intensity corresponding to their AT.

RESULTS: The AT was identified in 63 (77%) of the participants. Pearson correlation coefficients between the recommended heart rate and the heart rate at the AT were lower in cases of 40% HRR (r=.56) and 60% HRR (r=.50) than in cases of prescription based on the RPE (r=.86). Based on the RPE, 55% of the individuals would have been recommended to train at an intensity corresponding to their AT. This proportion was higher compared with 40% HRR (41%) or 60% HRR (18%) as criterion.

Conclusions: The AT can be identified in most individuals with PPS offering an individualized target for aerobic training. If the AT cannot be identified (eg, because gas analysis equipment is not available), intensity prescription can best be based on the RPE.

Outcome of Research: Not applicable

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Category: Exercise

Title: Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome
Author: Vreede KS, Henriksson J, Borg K, Henriksson M
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013 Sep;45(9):924-8. doi: 10.2340/16501977-1209.
Publication Year and Month: 2013 09

Abstract: OBJECTIVE: To evaluate gait in patients with post-polio syndrome, using the 6-minute walk test (6MWT) combined with three-dimensional kinematic analysis.

DESIGN: Descriptive study.

SUBJECTS: Eighteen patients and 11 healthy controls.

METHODS: Kinematic data were obtained during a 6MWT by a Vicon motion capture system. Distance, heart rate, leg tiredness, dyspnoea and exertion were also recorded.

RESULTS: Patients with post-polio syndrome showed larger increases in leg tiredness (p < 0.001) and dyspnoea (p < 0.05) as a result of the 6MWT than did controls. Walking speed decreased by 14.1% in patients vs 4.7% in controls (p < 0.05). Fourteen out of 18 patients displayed plantar-flexed ankle at initial contact (1/11 controls). At foot-off, the patients had a flexed hip (extended in controls) and a more flexed knee. Walking speed in patients correlated with hip angle at footoff, at the start (r = –0.60, p < 0.001) and the end of the 6MWT (r = –0.74, p < 0.001), being higher the more the hip was extended.

CONCLUSION: The 6MWT is fatiguing for patients with post polio syndrome, and this was reflected in the kinematic data. Walking speed was negatively correlated with the increased hip flexion, but not with the ankle plantar-flexion at foot-off in the patients with post-polio syndrome. The three-dimensional results underscore the importance of hip function in this patient group.

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Outcome of Research: Not applicable.

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Category: Exercise

Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01

Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.

Outcome of Research: Effective.

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Category: Exercise

Title: Endurance Training Effect on Individuals With Postpoliomyelitis
Author: Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar Grimby, MD, PhD
Affiliation:
Journal:
Citation: Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996;77:843-8.
Publication Year and Month: 1996

Abstract: Objective: To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.

Design: Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.

Setting: A university.

Subjects: Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.

Intervention: Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.

Main Outcome Measures: Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.

Conclusions: Results: Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.

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Category: Exercise

Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01

Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.

Outcome of Research: Effective.

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Category: Exercise

Title: Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription
Author: Voorn EL (1), Gerrits KH (2), Koopman FS (3), Nollet F (3), Beelen A (3)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected]; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2014 May;95(5):935-40. doi: 10.1016/j.apmr.2014.01.015
Publication Year and Month: 2014 05

Abstract: OBJECTIVES: To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT.

DESIGN: Cohort study.

SETTING: Research laboratory.

PARTICIPANTS: Individuals with PPS (N=82).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, gas exchange variables, heart rate, and rating of perceived exertion (RPE) were measured in an incremental submaximal cycle ergometry test. Two independent observers identified the AT. Comparison of current guidelines for training intensity prescription in PPS (40%-60% heart rate reserve [HRR] or RPE of 12) with the AT was based on correlations between recommended heart rate and the heart rate at the AT. In addition, we determined the proportion of individuals that would have been recommended to train at an intensity corresponding to their AT.

RESULTS: The AT was identified in 63 (77%) of the participants. Pearson correlation coefficients between the recommended heart rate and the heart rate at the AT were lower in cases of 40% HRR (r=.56) and 60% HRR (r=.50) than in cases of prescription based on the RPE (r=.86). Based on the RPE, 55% of the individuals would have been recommended to train at an intensity corresponding to their AT. This proportion was higher compared with 40% HRR (41%) or 60% HRR (18%) as criterion.

Conclusions: The AT can be identified in most individuals with PPS offering an individualized target for aerobic training. If the AT cannot be identified (eg, because gas analysis equipment is not available), intensity prescription can best be based on the RPE.

Outcome of Research: Not applicable

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Category: Exercise

Title: Submaximal exercise capacity and maximal power output in polio subjects
Author: Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Dec;82(12):1678-85
Publication Year and Month: 2001 12

Abstract: OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.

DESIGN: Cross-sectional survey.

SETTING: University hospital.

PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.

RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.

Conclusions: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.

Outcome of Research: Not applicable

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Category: Exercise

Title: The Postpolio Syndrome: An Overuse Phenomenon


Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

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(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Category: Exercise

Title: Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome
Author: Vreede KS, Henriksson J, Borg K, Henriksson M
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013 Sep;45(9):924-8. doi: 10.2340/16501977-1209.
Publication Year and Month: 2013 09

Abstract: OBJECTIVE: To evaluate gait in patients with post-polio syndrome, using the 6-minute walk test (6MWT) combined with three-dimensional kinematic analysis.

DESIGN: Descriptive study.

SUBJECTS: Eighteen patients and 11 healthy controls.

METHODS: Kinematic data were obtained during a 6MWT by a Vicon motion capture system. Distance, heart rate, leg tiredness, dyspnoea and exertion were also recorded.

RESULTS: Patients with post-polio syndrome showed larger increases in leg tiredness (p < 0.001) and dyspnoea (p < 0.05) as a result of the 6MWT than did controls. Walking speed decreased by 14.1% in patients vs 4.7% in controls (p < 0.05). Fourteen out of 18 patients displayed plantar-flexed ankle at initial contact (1/11 controls). At foot-off, the patients had a flexed hip (extended in controls) and a more flexed knee. Walking speed in patients correlated with hip angle at footoff, at the start (r = –0.60, p < 0.001) and the end of the 6MWT (r = –0.74, p < 0.001), being higher the more the hip was extended.

CONCLUSION: The 6MWT is fatiguing for patients with post polio syndrome, and this was reflected in the kinematic data. Walking speed was negatively correlated with the increased hip flexion, but not with the ankle plantar-flexion at foot-off in the patients with post-polio syndrome. The three-dimensional results underscore the importance of hip function in this patient group.

Conclusions:

Outcome of Research: Not applicable.

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Category: Exercise

Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09

Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.

Design: Observational study.

Participants: Thirty-three polio survivors, able to walk ≥ 150 m.

Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.

Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.

Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.

Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.

Outcome of Research: Effective

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Category: Exercise

Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03

Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.

The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.

Conclusions:

Outcome of Research: Not applicable

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Category: Exercise

Title: Polio residuals clinic: conditioning exercise program
Author: Owen RR, Jones D
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):882-3
Publication Year and Month: 1985 07

Abstract: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.

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Category: Exercise

Title: The use of strengthening exercises in post-polio sequelae - methods and results
Author: Feldman RM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):889-90
Publication Year and Month: 1985 07

Abstract: Some individuals who had poliomyelitis 20 to 30 years ago are now reporting a recurrence of symptoms of weakness in the same muscle groups that were weakened during the initial onset of the disease. Electrophysiological findings on EMG and repetitive stimulation studies identify changes peculiar to this disease. Non-fatiguing progressive resistive exercises have been used to strengthen muscle groups demonstrating this secondary weakness after the muscles have been identified by electrophysiological studies. Favorable results are reported after non-fatiguing exercises which, combined with Occupational Therapy and appropriate orthotic management, have resulted in improvement in function of ambulation and activities of daily living. The causes of muscle atrophy and pain seen in these individuals are also discussed.

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Category: Exercise

Title: Effect of modified aerobic training on movement energetics in polio survivors
Author: Dean E, Ross J
Affiliation: School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1243-6
Publication Year and Month: 1991 11

Abstract: Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.

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Category: Exercise

Title: The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome
Author: Fillyaw MJ, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A
Affiliation: Department of Physical Therapy, University of Vermont, Burlington
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1253-6
Publication Year and Month: 1991 11

Abstract: Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.

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Category: Exercise

Title: Post-polio fatigue: a 31P magnetic resonance spectroscopy investigation
Author: Thompson RT, Barton PM, Marsh GD, Cameron MG, Gravelle DG, Hsieh JT, Hayes KC, Driedger AA
Affiliation: Department of Nuclear Medicine, St. Joseph's Health Center, London, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1263-7
Publication Year and Month: 1991 11

Abstract: Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls using 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.

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Category: Exercise

Title: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae
Author: Jones DR, Speier J, Canine K, Owen R, Stull GA
Affiliation: Sister Kenny Institute, Minneapolis, Minn (Mr Jones and Drs Speier, Canine, and Owen)
School of Health Related Professions, State University of New York at Buffalo (Dr Stull)
Journal: The Journal of the American Medical Association
Citation: JAMA. 1989 Jun 9;261(22):3255-58
Publication Year and Month: 1989 06

Abstract: We examined the cardiorespiratory responses of 16 patients with postpoliomyelitis sequelae to a 16-week aerobic exercise program. The patients exercised at 70% of maximal heart rate. Dependent variables were resting and maximal heart rates, systolic and diastolic blood pressures, maximum oxygen consumption, maximum carbon dioxide consumption, respiratory quotient, and maximum expired volume per unit time. The exercise group was superior to the control group in watts, exercise time, maximum expired volume per unit time, and maximum oxygen consumption. No untoward events or loss of leg strength occurred as a result of the exercise regimen. We conclude that the aerobic training program employed in this study is a safe, short-term procedure and that patients with postpolio sequelae respond to training in a manner similar to healthy adults.

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Category: Exercise

Title: Postpolio syndrome and cardiopulmonary conditioning
Author: Owen RR
Affiliation: Sister Kenny Institute, Minneapolis, Minnesota 55407
Journal: The Western Journal of Medicine
Citation: West J Med. 1991 May;154(5):557-8 (Rehabilitation Medicine - Adding Life to Years [Special Issue])
Publication Year and Month: 1991 05

Abstract: Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.

Conclusions: Stretching and flexibility exercises are critical physical hygiene measures for the management of pain, instability, and deformity. These exercises should also precede cardiopulmonary conditioning and other vigorous physical pursuits. Muscle training and strengthening when carefully defined and judiciously implemented can safely build force and power. Resistive exercises should be prescribed for specific goals rather than for purposes of general muscle training. An adapted cardiopulmonary conditioning program has been created to provide improved cardiac status without the risk of overuse damage to nerve and muscle.

The management of postpolio syndrome requires applying traditional physical treatment principles with specific attention to the factors of the vulnerability of compensatory mechanisms to injury by overuse, underuse, underoxygenation, and an inefficient use of weakened musculature. Clinicians must provide information and a balanced prescription of exercise, rest, activity, support, and intelligent accommodation to additional disability.

Outcome of Research: Not applicable.

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There are currently 15 papers in this category.

Category: Exercise

Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09

Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.

Design: Observational study.

Participants: Thirty-three polio survivors, able to walk ≥ 150 m.

Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.

Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.

Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.

Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.

Outcome of Research: Effective

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Link to Paper (if available): Click here to view full text or to download


Category: Exercise

Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03

Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.

The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.

Conclusions:

Outcome of Research: Not applicable

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Exercise

Title: Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription
Author: Voorn EL (1), Gerrits KH (2), Koopman FS (3), Nollet F (3), Beelen A (3)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected]; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2014 May;95(5):935-40. doi: 10.1016/j.apmr.2014.01.015
Publication Year and Month: 2014 05

Abstract: OBJECTIVES: To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT.

DESIGN: Cohort study.

SETTING: Research laboratory.

PARTICIPANTS: Individuals with PPS (N=82).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, gas exchange variables, heart rate, and rating of perceived exertion (RPE) were measured in an incremental submaximal cycle ergometry test. Two independent observers identified the AT. Comparison of current guidelines for training intensity prescription in PPS (40%-60% heart rate reserve [HRR] or RPE of 12) with the AT was based on correlations between recommended heart rate and the heart rate at the AT. In addition, we determined the proportion of individuals that would have been recommended to train at an intensity corresponding to their AT.

RESULTS: The AT was identified in 63 (77%) of the participants. Pearson correlation coefficients between the recommended heart rate and the heart rate at the AT were lower in cases of 40% HRR (r=.56) and 60% HRR (r=.50) than in cases of prescription based on the RPE (r=.86). Based on the RPE, 55% of the individuals would have been recommended to train at an intensity corresponding to their AT. This proportion was higher compared with 40% HRR (41%) or 60% HRR (18%) as criterion.

Conclusions: The AT can be identified in most individuals with PPS offering an individualized target for aerobic training. If the AT cannot be identified (eg, because gas analysis equipment is not available), intensity prescription can best be based on the RPE.

Outcome of Research: Not applicable

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Category: Exercise

Title: Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome
Author: Vreede KS, Henriksson J, Borg K, Henriksson M
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013 Sep;45(9):924-8. doi: 10.2340/16501977-1209.
Publication Year and Month: 2013 09

Abstract: OBJECTIVE: To evaluate gait in patients with post-polio syndrome, using the 6-minute walk test (6MWT) combined with three-dimensional kinematic analysis.

DESIGN: Descriptive study.

SUBJECTS: Eighteen patients and 11 healthy controls.

METHODS: Kinematic data were obtained during a 6MWT by a Vicon motion capture system. Distance, heart rate, leg tiredness, dyspnoea and exertion were also recorded.

RESULTS: Patients with post-polio syndrome showed larger increases in leg tiredness (p < 0.001) and dyspnoea (p < 0.05) as a result of the 6MWT than did controls. Walking speed decreased by 14.1% in patients vs 4.7% in controls (p < 0.05). Fourteen out of 18 patients displayed plantar-flexed ankle at initial contact (1/11 controls). At foot-off, the patients had a flexed hip (extended in controls) and a more flexed knee. Walking speed in patients correlated with hip angle at footoff, at the start (r = –0.60, p < 0.001) and the end of the 6MWT (r = –0.74, p < 0.001), being higher the more the hip was extended.

CONCLUSION: The 6MWT is fatiguing for patients with post polio syndrome, and this was reflected in the kinematic data. Walking speed was negatively correlated with the increased hip flexion, but not with the ankle plantar-flexion at foot-off in the patients with post-polio syndrome. The three-dimensional results underscore the importance of hip function in this patient group.

Conclusions:

Outcome of Research: Not applicable.

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Category: Exercise

Title: Submaximal exercise capacity and maximal power output in polio subjects
Author: Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Dec;82(12):1678-85
Publication Year and Month: 2001 12

Abstract: OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.

DESIGN: Cross-sectional survey.

SETTING: University hospital.

PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.

RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.

Conclusions: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.

Outcome of Research: Not applicable

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Category: Exercise

Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01

Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.

Outcome of Research: Effective.

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Category: Exercise

Title: Endurance Training Effect on Individuals With Postpoliomyelitis
Author: Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar Grimby, MD, PhD
Affiliation:
Journal:
Citation: Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996;77:843-8.
Publication Year and Month: 1996

Abstract: Objective: To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.

Design: Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.

Setting: A university.

Subjects: Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.

Intervention: Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.

Main Outcome Measures: Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.

Conclusions: Results: Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.

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Category: Exercise

Title: Effect of modified aerobic training on movement energetics in polio survivors
Author: Dean E, Ross J
Affiliation: School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1243-6
Publication Year and Month: 1991 11

Abstract: Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.

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Category: Exercise

Title: The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome
Author: Fillyaw MJ, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A
Affiliation: Department of Physical Therapy, University of Vermont, Burlington
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1253-6
Publication Year and Month: 1991 11

Abstract: Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.

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Category: Exercise

Title: Post-polio fatigue: a 31P magnetic resonance spectroscopy investigation
Author: Thompson RT, Barton PM, Marsh GD, Cameron MG, Gravelle DG, Hsieh JT, Hayes KC, Driedger AA
Affiliation: Department of Nuclear Medicine, St. Joseph's Health Center, London, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1263-7
Publication Year and Month: 1991 11

Abstract: Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls using 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.

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Category: Exercise

Title: Postpolio syndrome and cardiopulmonary conditioning
Author: Owen RR
Affiliation: Sister Kenny Institute, Minneapolis, Minnesota 55407
Journal: The Western Journal of Medicine
Citation: West J Med. 1991 May;154(5):557-8 (Rehabilitation Medicine - Adding Life to Years [Special Issue])
Publication Year and Month: 1991 05

Abstract: Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.

Conclusions: Stretching and flexibility exercises are critical physical hygiene measures for the management of pain, instability, and deformity. These exercises should also precede cardiopulmonary conditioning and other vigorous physical pursuits. Muscle training and strengthening when carefully defined and judiciously implemented can safely build force and power. Resistive exercises should be prescribed for specific goals rather than for purposes of general muscle training. An adapted cardiopulmonary conditioning program has been created to provide improved cardiac status without the risk of overuse damage to nerve and muscle.

The management of postpolio syndrome requires applying traditional physical treatment principles with specific attention to the factors of the vulnerability of compensatory mechanisms to injury by overuse, underuse, underoxygenation, and an inefficient use of weakened musculature. Clinicians must provide information and a balanced prescription of exercise, rest, activity, support, and intelligent accommodation to additional disability.

Outcome of Research: Not applicable.

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Category: Exercise

Title: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae
Author: Jones DR, Speier J, Canine K, Owen R, Stull GA
Affiliation: Sister Kenny Institute, Minneapolis, Minn (Mr Jones and Drs Speier, Canine, and Owen)
School of Health Related Professions, State University of New York at Buffalo (Dr Stull)
Journal: The Journal of the American Medical Association
Citation: JAMA. 1989 Jun 9;261(22):3255-58
Publication Year and Month: 1989 06

Abstract: We examined the cardiorespiratory responses of 16 patients with postpoliomyelitis sequelae to a 16-week aerobic exercise program. The patients exercised at 70% of maximal heart rate. Dependent variables were resting and maximal heart rates, systolic and diastolic blood pressures, maximum oxygen consumption, maximum carbon dioxide consumption, respiratory quotient, and maximum expired volume per unit time. The exercise group was superior to the control group in watts, exercise time, maximum expired volume per unit time, and maximum oxygen consumption. No untoward events or loss of leg strength occurred as a result of the exercise regimen. We conclude that the aerobic training program employed in this study is a safe, short-term procedure and that patients with postpolio sequelae respond to training in a manner similar to healthy adults.

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Category: Exercise

Title: The Postpolio Syndrome: An Overuse Phenomenon


Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08

Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.

Conclusions:

Outcome of Research: Not applicable

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Comments (if any): Paul Cavendish
(Clinical Health Educator):
This article discusses manual muscle testing and gait dynamics with EMG, demonstrating excessive muscle use during gait, demonstrating increased fatigue for this sample of people with a history of polio.

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Category: Exercise

Title: Polio residuals clinic: conditioning exercise program
Author: Owen RR, Jones D
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):882-3
Publication Year and Month: 1985 07

Abstract: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.

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Category: Exercise

Title: The use of strengthening exercises in post-polio sequelae - methods and results
Author: Feldman RM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):889-90
Publication Year and Month: 1985 07

Abstract: Some individuals who had poliomyelitis 20 to 30 years ago are now reporting a recurrence of symptoms of weakness in the same muscle groups that were weakened during the initial onset of the disease. Electrophysiological findings on EMG and repetitive stimulation studies identify changes peculiar to this disease. Non-fatiguing progressive resistive exercises have been used to strengthen muscle groups demonstrating this secondary weakness after the muscles have been identified by electrophysiological studies. Favorable results are reported after non-fatiguing exercises which, combined with Occupational Therapy and appropriate orthotic management, have resulted in improvement in function of ambulation and activities of daily living. The causes of muscle atrophy and pain seen in these individuals are also discussed.

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Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications